Of course, the "eight for one rule" cannot be applied rigidly. But it
can be used as a general guide. Any attempt to calculate more
accurate figures would have to take into account that some events are more likely to traumatise people than others. For example, rape victims have a 50% risk of suffering PTSD following their ordeal while car crash victims have only a 20% chance. In addition, it would appear that some people may be more susceptible to PTSD than others, although there is no official agreement on this issue. These variables all have to be considered.
The generally agreed figure for the number of cases of PTSD within the population is 1½%. An enormous figure.
In some instances, the individual may have experienced a prolonged series of stressful circumstances. A Vietnam veteran may have experienced several traumatic combat incidents over a period of weeks or months. A fire officer may deal with a run of house fires in which children have been fatally burned. In cases
like these, the extensive cumulative stress can result in Prolonged Duress Stress Disorder (PDSD) which results in the same symptoms as PTSD. PDSD is now more frequently referred to as 'Complex PTSD' by many commentators.
Complex Post Traumatic Stress Disorder may be experienced by some unlikely victims. For example, Dr Iain West is Britain's leading forensic pathologist. He experiences on a daily basis sights that most people would find physically and emotionally abhorrent. His job is to carry out physical examinations of victims of fatal crimes, or accidents. He led investigating teams to deal with the aftermath of the Hillsborough, King's Cross and Clapham disasters. Dr West has also been deeply involved with cases of suicide, murder and child abuse. Following the case of baby Tyra Henry, a twenty-one-month-old infant who was dropped in a fight between her parents, Dr West was quoted (Stern 1996) as saying, "The examinations of both Jasmine (Tyra's sister) and Tyra have left images that I will always have in my mind - the state of their little bodies the first time I saw them. I will never forget them." Perhaps
someone in this position is likely to become a victim of Complex PTSD.
IS WHAT I AM EXPERIENCING NORMAL?
There are over 6,000 million people on this planet. Consequently, there are the same number of different reactions to any situation. No two people will have an identical reaction to one event. That is what makes us human. Two people who experience the same event together will react to it differently. If there are two hundred people present, the variety of reactions is multiplied by that number, the only difference in a large group is that several people may have broadly similar reactions. Confronted by a traumatic situation some will face it, others will move away. This reaction is referred to as `fight or flight' .If the event is particularly traumatic, many will run the risk of developing PTSD.
Who can say what is normal? What can be said, without fear of contradiction, is that a person who is faced with an abnormal situation will react in some way to that situation. How the person reacts will depend on many other factors, such as previous experiences, mood at the time of the event, and individual perception of the threat to personal safety.
Suppose you are leaving the cinema one evening and you come face to face with a youth. He waves a sharp knife under your nose and demands all your cash. It is likely that you first feel fear, then anger, then logic takes over and you reason no amount of cash is worth a slashed face. The youth grins wildly, waves your money under your gaze to signify his victory, and runs off.
If, three weeks later, you are leaving a cinema and someone rushes up to you brandishing your forgotten coat, your first reaction is one of panic. Your mind, briefly, links the two events because some aspects of the first traumatic event have been repeated in the second, friendly, incident. Most people familiar with the circumstances of the robbery will see your initial panic reaction as normal. People witnessing the second event, not knowing about the robbery, might consider your initial panic as rather unusual. It is all a matter of perception and understanding.
Radiation is widely perceived as a threat to life. Few of us fully understand it or can visualise it, but we all know it can kill. In March 1979 there was a radiation `incident' at Three Mile Island in America. Three Mile Island is situated near Harrisburg, Pennsylvania. The incident was contained within the power station complex. There was no real risk to the residents of the town. However, only a few months before that incident, a film describing a fictional nuclear accident had been released. The China Syndrome, starring Jane Fonda, told
the story of a negligent power company searching for greater profits at the expense of safety. The result was the ultimate nightmare of a nuclear meltdown.
The nuclear lobby rubbished The China Syndrome as alarmist. However, at Three Mile Island, Hollywood drama was being acted out in real life. Naturally, people's perceptions of the risks involved had been altered by the film. There were no fatalities in Pennsylvania, but large numbers of people panicked and became severely traumatised by the incident. In the circumstances, this panic was both normal and reasonable.
The situation was to be repeated in 1986, this time at Chernobyl in Russia. The consequences on that occasion were far more devastating.
AM I GOING MAD?
Post Traumatic Stress Disorder is a psychological phenomenon. It is an emotional condition, from which it is possible to make a full and complete recovery.
The most distressing symptom of PTSD is the reliving of the traumatic event, whether you want to or not. This re-experiencing may take the form of recurrent nightmares, or daytime flashbacks. In either case you are troubled by vivid, repetitive pictures of the trauma. Sometimes these pictures are so real that you start to behave as though the event is happening all over again. This re-experiencing may last only a few seconds, but it might last hours or even days initially. Often you are fully aware of what is happening but can do nothing to control the situation. The flashbacks can occur with distressing frequency, adding fuel to the erroneous belief that you are `going mad'. The memory of the event is usually in picture form. Sounds and smells can act as a trigger to start the picture sequence. Former Middle East hostage, Terry Waite, tells how the sound of ripping masking tape triggered terrible memories of his days in captivity (Waite 1993). Chained and blindfolded in a tiny cell, he was frequently moved from one `safe house' to another. Before every move he was bound with masking tape; even his mouth and eyes were covered. It is little wonder that a harmless and familiar sound to many should be such a traumatic trigger for him.
Because these vivid flashbacks are so unpredictable, victims find themselves at a disadvantage. Former friends and colleagues may feel insecure and unsure about how to react. Canteen chatterers may start to label the victim as a `nutter' or a `head case' .These labels are not appropriate to anyone, and they are certainly not appropriate descriptions of a PTSD victim. Unfortunately, the labels tend to stick. Victims start to panic. They avoid situations or activities which are likely to trigger the images. Their lifestyle changes and they start to lose contact with other people. This spiral of events may lead to feelings of depression and anxiety. Untreated, this can have dangerous and far-reaching consequences. Resultant poor attendance at the workplace may result in unemployment, and irritability often adds strain to all personal relationships. All this, combined with possible uncontrollable and violent outbursts during periods when the victim is re-experiencing the trauma, can add up to an unbearable life. Things cannot continue in this way for long.
In seeking medical help, the last straw for PTSD victims is to picture themselves as mentally irredeemable cases doomed to spend the rest of their lives in a Dickensian-style institution for the insane.
This is a false expectation, but one common to many PTSD sufferers. They are not mad, but they do require specialised help.